Osman Dina, Umar Seemeen, Muhammad Humayun, Nikfekr Esmaeil, Rostami Kamran, Ishaq Sauid
North Cumbria University Hospital NHSF Trust, UK.
York Teaching Hospital, NHSF Trust, UK.
Gastroenterol Hepatol Bed Bench. 2021 Winter;14(1):1-7.
Coeliac disease (CD) is a gluten-induced enteropathy affecting 1% of the population and has extra intestinal manifestations. One such expression involves nervous system, and CD may present as gluten ataxia (GA), peripheral neuropathy and epileptiform disorder among others. Considerable controversy exists on the exact pathophysiological mechanism of gluten leading to ataxia. It is, however, clear that in intestinal axis tissue transglutaminase 2 (tTG2) is the primary target but in the nervous system, tTG6 may be the causative antigen although its exact role is not clear. Furthermore, it has also been postulated that anti-gangliodise antibodies may play a role in the emergence of central pathology if not the key contender. Moreover, the association of neurological injury with non-coeliac gluten sensitivity (NCGS), a related but pathologically different condition implies an independent mechanism of neuronal injury by gluten in the absence of CD. This review will touch on the salient features of CD and the nervous system and will highlight current controversies in relation to gluten and GA.
乳糜泻(CD)是一种由麸质引起的肠病,影响着1%的人口,并且有肠外表现。其中一种表现涉及神经系统,CD可能表现为麸质共济失调(GA)、周围神经病变以及癫痫样障碍等。关于麸质导致共济失调的确切病理生理机制存在相当大的争议。然而,很明显在肠道轴中组织转谷氨酰胺酶2(tTG2)是主要靶点,但在神经系统中,tTG6可能是致病抗原,尽管其确切作用尚不清楚。此外,也有人推测抗神经节苷脂抗体即使不是关键因素,也可能在中枢病理的出现中起作用。此外,神经损伤与非乳糜泻性麸质敏感(NCGS)的关联,这是一种相关但病理不同的病症,意味着在没有CD的情况下,麸质对神经元损伤有独立的机制。本综述将涉及CD与神经系统的显著特征,并将突出当前与麸质和GA相关的争议。